Wall Street Journal Drops the Ball on No Surprises Act Editorial

Throughout today’s media landscape, we unfortunately continue to see one-sided takes on today’s most important issues.

But then there’s one of the country’s most prominent newspapers publishing its opinion as if it were ghostwritten by Elevance Health’s executives.

That’s exactly what we saw in the Wall Street Journal’s recent editorial, “The ‘Surprise Billing’ Racket.”

The real racket? That’s health insurance companies’ anticompetitive and egregious behavior in the No Surprises Act’s Independent Dispute Resolution (IDR) process. Yet, the Journal’s editorial board argues that the “No Surprises Act of 2020…has had consequences nearly the opposite of what was intended.”

Really?

Clearly, the editorial board failed to do its homework. The main intention of the No Surprises Act was to protect patients and remove them from surprise medical bill disputes between medical providers and health insurers. Everyone, including insurers, agrees this has been resoundingly successful. Additionally, Congress also established the law’s arbitration process to decide out-of-network payment disputes that can’t be resolved through open negotiation.

This process is administered by expert healthcare arbitrators, known as IDR entities (IDREs). They’re certified by the Centers for Medicare & Medicaid Services (CMS). And the process is well known to be self-correcting, pushing both disputing parties to make reasonable offers since the less reasonable offer loses.

Medical providers are now winning these federal IDR decisions about 85% of the time. But that’s not because the IDR system is a “racket,” as the Journal and health insurers would lead you to believe. It’s because health insurers are making low-ball offers in arbitration that have no resemblance to fair market rates. In fact, health plans are making tens of thousands of $0 or $1 offers in IDR for medical care already performed, losing those disputes, and then complaining the system is unfair.

Shame on anyone who takes that seriously.

Even more troubling, health plans are simply failing to show up to arbitration. Recent public data released by CMS shows that there are hundreds of thousands of IDR cases that providers have won by default, meaning the health plan didn’t even bother to make an offer. In Q2 2025 alone, health plans filed no offer at all and lost by default 352,327 times.

As our President Christopher Sheeron noted recently for the New York Times, “The only gaming of the system is being done by insurers. They are losing in federal arbitration on purpose in an effort to overhaul the law in their favor.”

Indeed, to pull the wool over policymakers and the public’s eyes, insurers are now undertaking a multi-million-dollar public relations smear campaign to push Congress to alter the arbitration process. As part of this process, which is now playing out in major media outlets like the Journal, they have gone about demonizing doctors, physician assistants, nurses, hospitals, revenue cycle management companies, and even legislators. And health insurers and their think tank allies are now saying the IDR process will lead to increased premiums and even lost wages.

Here’s the dirty secret they don’t want you to know. According to health insurers’ own data, a small fraction of claims each year that could be submitted to IDR (about 6%) ever actually reaches the IDR process. Their arguments, therefore, have no merit. It’s easy for gigantic insurance corporations to dump millions of dollars into spinning the truth. But it’s hard to hide from your own facts.  

Ironically, the only ones who are allegedly not to blame in the IDR process are the health insurance companies themselves that are reaping tens of billions of dollars of profit every year and paying their senior executives eight-figure compensation packages. And although these insurers are the dominant players in the healthcare market, they want you to believe that the huge annual premium hikes that they impose year after year are because of everyone else. Recall, due to the medical loss ratio (MLR) created by the Affordable Care Act (ACA), health insurers’ profits are directly tied to overall premiums. The higher the premiums, the higher their profits.

The truth is indisputable: federal IDR payments amount to less than 1% of total national healthcare spending. To claim that’s having a real impact on patient premiums or costs just doesn’t add up.

Despite what the Journal’s editorial board has written, the No Surprises Act is working exactly as intended. It has protected tens of millions of patients from surprise medical bills. The law is the first sign of hope in many years for addressing insurers’ long-standing underpayment to medical providers. And it’s holding health insurers accountable for their behavior while helping to reduce healthcare consolidation.